What We Have Here is Failure To Communicate

I get nervous when I talk to people. I have a naturally high baseline anxiety level—it’s just how I’m wired—and I know this is a big part of my interpersonal nervousness. But part of it is also a learned anxiety because from long experience I know there’s a high likelihood that when I open my mouth, I’m going to be misunderstood. My palms get sticky, pit stains bloom, and my heart flutters, especially when I’m talking to teachers, plumbers, hotel concierges, dental hygienists, my in-laws, massage therapists, other parents, telephone solicitors—

and doctors.

How I feel after a doctor visit.

How I feel after a doctor visit.

Oh, the long history of mutual misunderstanding I have with doctors.

I try to give them the benefit of the doubt. They’re human; they’re busy. Yes, I’m paying them (or my insurance is), but there are myriad reasons they’re not necessarily able to give me their full attention. And since I’m the common thread between all of these doctors and all of this misunderstanding, I’ve racked my brain to think of what I must be doing to contribute to the miscommunications, and over the years I’ve modified my approach.

Following the advice of websites and insurance company publications, I take in my written list of questions (prioritized by importance), so I can hit the high points and don’t flail about trying to remember what I was supposed to ask about. In addition, I do deep breathing exercises in the waiting room, tap into self-hypnosis techniques, and do lovingkindness meditation just for good measure, and still I leave the office feeling rushed and befuddled.

Sometimes it’s like they physically can’t hear me, so I try to speak up. Other times, they seem frustrated or annoyed when I ask them questions, which I read as defensiveness (and which doesn’t do much to decrease my anxiety). Sometimes they have a treatment recommendation in mind before they’ve asked me what I’ve already tried. Example:

doctor: “You’ll lose weight easier if you add weight training to your exercise routine.”

me: “I do weight training every morning.”

doctor: “Well, you should do upper body, not just lower body.”

me: “I do upper bo—“

doctor: “Okay, open your mouth and stick out your tongue!”

And still other times, it’s as though I’ve calmed myself so much that I can’t convey with my voice the importance of what I’m trying to say. Several years ago, our pediatrician gave me his cell phone number with the instruction that if my newborn’s temperature went above 102, I was to call him immediately. My voice mail to him went something like this: “Um, so you said to call if my son’s temperature went above 102, and it went up to 102.5, and something weird happened that I think might have been a seizure. So, could you call me back?”

He didn’t call back, and when I asked him about it at our appointment a few days later, he said he didn’t call me back because I didn’t sound concerned on the voice mail. “If I’d known it was that serious I would have called you back,” he said.

I had absolutely no idea what to do with this feedback except to think back to all of those courtroom shows I used to watch and worry that if I ever had to defend myself in court, I wouldn’t show enough emotion and the jury would convict me of whatever horrible thing I’d erroneously been accused of. (Have I mentioned I have a tendency towards anxiety?)

My new doctor has this online patient portal thing through which I can ask the office questions about treatment in writing.

In writing! O frabjous day! I’m much less anxious when I write! I’m even somewhat intelligible at times! Surely this would solve my communication issues with doctors!

With much optimism, I responded to a message my doctor’s office sent about some lab results. I responded with seven questions. Yes, this is normally way too many questions for an e-mail, but it’s how many I had. And I was writing to a medical professional, with the straight A’s and the years of schooling and the 100-hour a week residencies. Surely this person could handle a seven-question e-mail. I even numbered them for her convenience.

A couple of hours later, I got her response. It was five lines long with one short sentence per line. It answered four questions, but only two of those were questions I’d asked. I wondered if she had a select-a-response like customer service reps use, but that didn’t seem like a very charitable thought so I pushed it aside.

“Okay,” I thought. “I asked too many questions that first time. What is the most important question out of those seven?”

I crafted another e-mail, highlighting just the one question and admitting that I was feeling confused. I did not say that I was feeling confused because she wasn’t answering my questions because I was trying hard not to be passive aggressive.

About an hour later, I got another response which still didn’t answer my question. My one question. And it was still written in five lines with just a few words per sentence. I wondered if the portal had some Twitter-like limit on how many characters she could use in her answer or if maybe she thought I could only read at a fifth grade level.

Undaunted, I wrote back again, this time rephrasing something she had written in her most recent e-mail and asking for clarification, hoping to lead her to actually answer the question I had asked twice already.

Her response this time was only three lines long and not only didn’t answer my question, but contradicted something she had written in her first e-mail. And then she told me to make an appointment with the nurse practitioner because I have so many questions.

So, I gave up.

I suspect avoidance isn’t the best course of action here (I’m going to have to talk to a doctor at some point, even if I don’t talk to this one again), but I’m not sure how else to prevent this kind of Kafkaesque exchange.

Is it really just me, or do other people have trouble communicating with medical professionals?

13 comments

  1. akiraa9 · March 29, 2015

    i wish dat the problem could be solved as fast as possible so we can have less problems in our lives!! Such a gud topic n nice writin! Keep it up!! 🙂

    Like

  2. Ellery Davies · March 10, 2015

    Great piece, Charity — and an impressive set of replies, all on the first day of publication.

    I wonder if you could get clear answers and more apparent concern for your questions by adding a preface (i.e. to conversation with doctor or portal-person). Perhaps the preface can be something like this:

    “I seek answers to specific questions about my health (my test results, the doctor’s instructions, etc). I would rather discuss these concerns with my doctor, but I am happy to begin the conversation with this portal…

    “My questions are numbered, because I have been disappointed in the past, due to a disconnect between my questions and a response that seems limited or unrelated to my specific concerns.

    “In addition to a reply that includes no “boilerplate” scripts (because they can so easily drift apart from my specifics), I would very much appreciate a follow up call. I really do need to talk with someone knowledgeable about my medical history, my recent test results, and my individual concerns.

    The goal of this “preface” may seem obvious (to awaken the machine), but it has another goal. It subtly acknowledges that the difficulty in getting clear answers from the standard approach may be due, in part, to your own limitations. This absolves the practitioner (and associates) of blame, while reinforcing their ability to resolve your issues by simply considering your request with a bit better feedback and personal attention.

    If this doesn’t get attention and a reasonable response, then I would switch doctors.

    Like

    • Charity · March 10, 2015

      I think a preface like the one you suggest could be a good idea, Ellery, but I fear that those receiving it via the portal wouldn’t actually read it. But then, my inclination towards simplicity in my subsequent messages didn’t seem to improve the situation, so perhaps your preface would be a more effective option. I certainly think it’s a good idea when I meet a new doctor to explain (briefly) what I hope to achieve through my questions—a better understanding of what the physician says so I can take an educated and active role in my own medical care—and perhaps begin the relationship in a spirit of collaboration. I suspect this would turn off some doctors but would be welcome (I hope) to the type of doctor I’d like to have.

      Like

  3. Tucker · March 9, 2015

    ugh, I feel like medical professionals are, at best, consultants. They are people that I pay for an opinion. If they don’t give me an opinion, or if it’s clear that they didn’t think about the opinion that they gave, I find myself another consultant. This is one of those “easier said than done” tasks, and has caused us a lot of grief over the years. Now that we are traveling, it’s become a bit of a mixed bag. We have a lot of flexibility, but very little in the way of consistency. We end up having to make our own calls more often than not. I’m not sure if this is a good thing or not, but it does mean that I’m quite a bit more critical, and I tend to act more like my doctor has to convince me that she is right, before I will follow her advice.

    Like

    • Charity · March 9, 2015

      I relate to this, Tucker: “I’m quite a bit more critical, and I tend to act more like my doctor has to convince me that she is right, before I will follow her advice.”

      Do you find that doctors get defensive when you ask for more information about a recommendation they’ve made? Most I’ve encountered say they want their patients to be active participants in their medical care, but only a couple have actually responded positively when I’ve tried to put that into practice by asking questions.

      I don’t know if it’s a result of my nomadic background or something else (perhaps my penchant for avoidance), but I fairly readily switch doctors anymore. My kids have had four doctors and I’ve had three (soon to be four) in the not quite four years we’ve lived here. (My spouse, lucky duck, hasn’t had any.) It gets tiring, with all the records swapping and negotiating new computer systems, but it’s better than sticking with someone who’s not working for me or my kids.

      Like

  4. Jen Swann Downey · March 9, 2015

    So bleeping not-funny funny. I say this as a person who has had similar trouble! Thanks for putting the experience into words….

    Like

    • Charity · March 9, 2015

      You’re welcome! It’s been very therapeutic to vent a bit here, and even more so to hear from others with the same trouble.

      Like

  5. morganmg78 · March 9, 2015

    I’m a nurse, and I often feel like when it comes to myself, (with my own dr for me or kids) I often don’t know the proper way to ask my questions. I feel like an idiot sometimes.

    Like

    • Charity · March 9, 2015

      I used to be a doula and am from a family of nurses, and still I can’t seem to figure out what to say or how to say it in the span of time I have allotted to me. I sometimes think I should take a buddy to all of my appointments with me, so she/he can do the talking for me.

      Like

  6. realophile · March 9, 2015

    i am a medical professional and only recently found an MD i can connect with. worth his weight in gold.

    i relate to your post on a lot of levels.

    Like

    • Charity · March 9, 2015

      This is a comfort to me, realophile. I have connected with doctors in the past, so I know they’re out there, they just seem difficult to find.

      Liked by 1 person

  7. cavellemartin · March 9, 2015

    Such a good topic! I can relate to your anxiety. Along with Bipolar disorder I also have General Anxiety Disorder. The anxiety was getting so bad that meds was eventually the route I took. That being said I have had similar issues with doctors. Trying to be assertive when you’re worrying about a million things at the same time is very difficult.

    It is really important though that you put your foot down. I think it’s a crock of sh*t that your doctor tried to pass the buck to you when you made the phone call. The phone call he TOLD you to make but now it’s your fault because you didn’t sound concerned enough? I think you might do what I do and look at people like doctors and teachers as people above you. They’re not. Sure they have the degree but you have a voice and it counts.

    I finally took the bull by the horns with my family doctor. One appointment I had with him I just made myself very clear. Of course I worried I was being too aggressive but you know what? He listened and actually addressed my issue. It’s not pleasant but sometimes you have to that person you’re not used to being. Otherwise people will just walk all over you and when it comes to your health your doctor doesn’t have to like it. You’re not there to be friends. You’re there because you and your health are a priority. If you don’t take yourself seriously, trust me, your doctors won’t either.

    Like

    • Charity · March 9, 2015

      Thank you so much for your words of support, cavellemartin! I’m trying to remember that I am a consumer of medical care and that I actually do get to call the shots or take my business elsewhere, but I still haven’t learned how to do that while I’m wearing that thin little gown.

      Like

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